With the month of March being recognized as Colorectal Cancer Awareness Month, it is necessary to discuss the importance of colorectal cancer prevention and screening. Of the malignancies affecting both men and women, colorectal cancer is the 3rd most frequently diagnosed and 2nd leading cause of cancer-related deaths in the United States. Despite these statistics, the incidence and mortality from colorectal cancer has decreased over the years. This is likely the result of a better understanding of the factors that increase one’s risk for developing colorectal cancer and through improved screening efforts.
As with most cancers, a number of factors may increase the risk of developing colorectal cancer and include age, gender, race, genetics and lifestyle factors. The risk of colorectal cancer increases with age with the majority of those affected being diagnosed after age 50. In terms of gender, the incidence rates in men are approximately 30% higher. With regards to race, African Americans are more likely to be diagnosed with and die from colorectal cancer compared to any other racial/ethnic group. While the majority are diagnosed in individuals without a family history of the disease, of those that do, the risk of developing colorectal cancer is higher and tends to influence screening recommendations. Finally, studies have shown that lifestyle factors may have an impact on colorectal cancer prevention with patients who are active, of a healthy weight, abstain from smoking, and limit their alcohol consumption having lower rates of colorectal cancer.
Screening is instrumental in preventing cancer through the detection and removal of precancerous polyps. It can also detect cancers at an earlier stage when treatment is more successful. While there are a number of screening modalities available (visual and stool-based), colonoscopy remains the gold standard as it allows for both the identification and removal of precancerous polyps. It is recommended that non-African Americans at average risk have their first colonoscopy at 50. Because of their increased risk, African Americans should have their first colonoscopy at age 45 and possibly even earlier for those with a family history of the disease. Alternatives to colonoscopy include flexible sigmoidoscopy, CT colonography and stool-based modalities (i.e. FOBT, FIT). Note that while less invasive, these studies may miss small precancerous polyps and therefore need to be performed more frequently. Furthermore, if abnormalities are found, subsequent colonoscopy is usually required.
Although significant strides have been made in the detection and treatment of colorectal cancer, it continues to be a leading cause of cancer-related deaths. Patients however, have the ability to reduce their risk by engaging in healthy lifestyle behaviors and by ensuring they are getting properly screened.
Article written by Ashley Hardy, MD in Spring 2018 Link for Hope newsletter.
Colorectal Cancer Awareness